Martínez Jairo Alberto Espinoza, Pinsker Marcus O, Arango Gabriel J, Garcia Xiomara, Oscar Andrés Escobar V, Furlanetti Luciano, Reithmeier Thomas, Aranda Iñigo Alonso Aguirre, Marin Jorge Humberto, Lopez William Omar Contreras
Department of Stereotactic and Functional Neurosurgery, Movement Disorders and Pain Clinic - CIMAD, Carrera 19A No. 82-14, Bogotá, Colombia; Department of Neurosciences, Marly Clinic, Calle 50 No. 9-67, Bogotá, Colombia.
Department of Stereotactic and Functional Neurosurgery, HELIOS Klinikum Berlin-Buch Medical Center, Schwanebecker Chaussee 50, 13125 Berlin, Germany; Department of Stereotactic and Functional Neurosurgery, University Medical Center, Breisacher Straße 64, 79106 Freiburg, Germany.
Clin Neurol Neurosurg. 2014 Aug;123:191-8. doi: 10.1016/j.clineuro.2014.05.012. Epub 2014 May 29.
In this study, we assessed the outcomes of patients with dystonia who underwent surgery treatment following the same algorithm.
Eighty consecutive patients with dystonia were submitted to neurosurgical management by means of intrathecal pump implantation, pallidotomy or deep brain stimulation (GPi or VIM). These patients included 48 patients with primary dystonia and 32 patients with secondary dystonia. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to access pre- and post-operative outcomes. Patients were followed from 12 to 114 months.
Mean improvement in BFMDRS score among patients with PrD was 87.54% and 42.21% for SeD. Hemidystonic patients in both groups (PrD, SeD) showed a mean improvement in BFMDRS of 71.05% with GPiDBS. Patients with SeD due to previous perinatal insults showed a mean improvement in BFMDRS of 41.9%, with better results in purely dyskinetic patients (mean improvement of 61.2%).
Use of the proposed algorithm facilitated surgical decision planning, which translated in improved diagnostic rates, earlier interventions, appropriate management plans, and outcomes for both groups (PrD, SeD). Therefore, neuroimaging findings had a positive prognostic significance in the response to treatment in patients with primary dystonia compared with patients with secondary dystonia or distortion of basal ganglia anatomy. However, further studies in this line are warranted.
在本研究中，我们评估了按照相同算法接受手术治疗的肌张力障碍患者的治疗结果。
连续80例肌张力障碍患者接受了神经外科治疗，治疗方式包括鞘内泵植入、苍白球切开术或脑深部电刺激术（丘脑底核或腹中间核）。这些患者包括48例原发性肌张力障碍患者和32例继发性肌张力障碍患者。采用伯克-法恩-马斯登肌张力障碍评定量表（BFMDRS）评估术前和术后结果。对患者进行了12至114个月的随访。
原发性肌张力障碍（PrD）患者的BFMDRS评分平均改善率为87.54%，继发性肌张力障碍（SeD）患者为42.21%。两组（PrD、SeD）的偏侧肌张力障碍患者接受丘脑底核脑深部电刺激术（GPiDBS）后，BFMDRS评分平均改善率为71.05%。既往有围产期损伤所致继发性肌张力障碍患者的BFMDRS评分平均改善率为41.9%，单纯运动障碍患者的结果更好（平均改善率为61.2%）。
使用所提出的算法有助于手术决策规划，这转化为提高了诊断率、更早的干预、适当的管理计划以及两组（PrD、SeD）患者的治疗结果。因此，与继发性肌张力障碍患者或基底节解剖结构扭曲的患者相比，神经影像学检查结果对原发性肌张力障碍患者的治疗反应具有积极的预后意义。然而，有必要对此进行进一步研究。
